Tuesday, 28 October 2008

More delays to NPfIT

(By Richard Holway & Anthony Miller) The front page of today’s FT (see here) and a follow-on piece (see here) provide grim reading for followers of Connecting for Health’s National Programme for IT (NPfIT) and indeed, for all of us that depend on our health service. The articles note, among other things, that “CfH’s most recent published plans for the next three months do not include a single installation of a patient administration system into any acute hospital trust”. Looking at this very document (see here) the FT’s assertion appears correct.

The articles refer to a recent litany of delays and cancellations highlighted on the superb e-Health Insider website, essential reading for all followers of the programme. Indeed, the FT reports seem to be based on an eHealth Insider report of 21st Oct 08 - Lorenzo stalled at Morecambe Bay.

We have also commented endlessly on the NPfIT’s trials and tribulations since its inception. Accenture and Fujitsu have both pulled out (see Fujitsu pulls out of NHS IT), at huge cost to the suppliers (to lose one supplier is unfortunate; to lose two …) causing massive disruption the programme. Isoft was almost driven out of business. It is still not clear which of the ‘last men standing’ (BT or CSC) will take over Fujitsu’s patch, though BT has to be the firm favourite.

It’s hardly appropriate to do a post-mortem on the programme, though its possible demise was hinted in NHS IT policy specialist Frances Blunden’s quote that “It is a little bit too early to pronounce the programme dead”. If so, this would be a disaster from so many angles.

The strict – indeed harsh – contracts negotiated by Richard Granger in his time as Director General of the project, has meant that HM Government has actually underspent to date. But one thing is clear. IT healthcare projects should carry their own health warning for suppliers.

Yesterday I had lunch with the head of another major IT supplier to the public sector who was hurting/bleeding over another major contract. Just like Accenture and Fujitsu, they had entered into it with their eyes open. They, and none of the other suppliers mentioned above, were “IT Virgins”. So, from one viewpoint, it is difficult to have much sympathy.

However, in my long ‘career’ in IT, I have learnt that the best contracts are where both customer and vendor believes they have a good deal. Where the customer realises that he is actually in a better position, gets a better service and end-product if the vendor makes a reasonable profit. These big IT projects are true partnerships. If all the suppliers to the NHS IT Project (or any public sector contracts) walk away or, at worst, go bust everybody loses and nobody gains a bean.

The other point which has been made repeatedly is that the NHS IT Project’s objective were both too grand and too ‘national’. The original decision to exclude the many established local players from the system was just plain daft. Excluding the GP’s favourite – EMIS – from the system caused a huge backlash against the system. It was reversed but the damage had been done.

That’s why my attention was drawn to another EHealth Insider article of 24th Oct 08 – NHS not making enough use of technology. It reports on a Kings Fund (my very first employer back in 1966!) report on the use of IT in the NHS. Its conclusion was that the NHS was making too little use of basic IT functions – like email and the internet. My own experience with the NHS would bear this out. Embracing readily available (and cheap!) technology might well provide more benefits, more cheaply and much quicker than any grandiose NPfIT project.

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